A randomized trial of adenotonsillectomy for childhood sleep apnea
Carole L Marcus, Reneé H Moore, Carol L Rosen, Bruno Giordani, Susan L Garetz, H Gerry Taylor, Ron B Mitchell, Raouf Amin, Eliot S Katz, Raanan Arens, Shalini Paruthi, Hiren Muzumdar, David Gozal, Nina Hattiangadi Thomas, Janice Ware, Dean Beebe, Karen Snyder, Lisa Elden, Robert C Sprecher, Paul Willging, Dwight Jones, John P Bent, Timothy Hoban, Ronald D Chervin, Susan S Ellenberg, Susan Redline, Childhood Adenotonsillectomy Trial (CHAT), Jean Arnold, Mary Ellen Carroll, Mary Anne Cornaglia, Beth Ann Compton, Casey Critchlow, Judith Emancipator, Melissa Fernando, Theresa Friederich, Amanda Goodman, Xiaoling Hou, Elise Hodges, Laurie Karamessinis, Kim Lacy, Megan McDougall, Daniel Mobley, Michelle Nicholson, Angela Orlando, Deborah L Ruzicka, Gauri Sathe, Nancy Scott, Susan Surovec, Omarya Vega, Xingmei Wang, Catherine Williams, Lynn Taussig, Thomas Anders, Julie Buring, Karina Davidson, Estelle Gauda, Steven Piantadosi, Bennett Shaywitz, Benjamin Wilfond, Tucker Woodson, Robert Zeiger, Carole L Marcus, Reneé H Moore, Carol L Rosen, Bruno Giordani, Susan L Garetz, H Gerry Taylor, Ron B Mitchell, Raouf Amin, Eliot S Katz, Raanan Arens, Shalini Paruthi, Hiren Muzumdar, David Gozal, Nina Hattiangadi Thomas, Janice Ware, Dean Beebe, Karen Snyder, Lisa Elden, Robert C Sprecher, Paul Willging, Dwight Jones, John P Bent, Timothy Hoban, Ronald D Chervin, Susan S Ellenberg, Susan Redline, Childhood Adenotonsillectomy Trial (CHAT), Jean Arnold, Mary Ellen Carroll, Mary Anne Cornaglia, Beth Ann Compton, Casey Critchlow, Judith Emancipator, Melissa Fernando, Theresa Friederich, Amanda Goodman, Xiaoling Hou, Elise Hodges, Laurie Karamessinis, Kim Lacy, Megan McDougall, Daniel Mobley, Michelle Nicholson, Angela Orlando, Deborah L Ruzicka, Gauri Sathe, Nancy Scott, Susan Surovec, Omarya Vega, Xingmei Wang, Catherine Williams, Lynn Taussig, Thomas Anders, Julie Buring, Karina Davidson, Estelle Gauda, Steven Piantadosi, Bennett Shaywitz, Benjamin Wilfond, Tucker Woodson, Robert Zeiger
Abstract
Background: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.
Methods: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months.
Results: The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%).
Conclusions: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.).
Conflict of interest statement
No other potential conflict of interest relevant to this article was reported.
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Source: PubMed